colleagues (1992) to estimate smoking-related mortality. She also looked at 8 high-income countries instead of the 21 that Preston and colleagues worked with, and she focused on women aged 65 and older instead of considering both men and women aged 50 and older as Preston’s group did. Her results are very much in line with those of Preston and colleagues—she, too, concludes that a large part of the divergence in female life expectancy trends among various high-income countries can be attributed to smoking patterns—but she offers some additional perspectives that are worth noting.

First, Staetsky observes that the eight countries she studied fall into two obvious clusters, each with similar mortality trends and smoking patterns among women. In the first cluster, consisting of the United States, Denmark, the Netherlands, and England and Wales, a large percentage of women—one-third or more—were smoking during the 1970s. Women in the second cluster, consisting of France, Italy, Spain, and Japan, had much lower rates of smoking. Mortality from lung cancer and other smoking-related diseases was relatively low for women in this second cluster of countries during the 1980s and 1990s, and their life expectancy rose steadily throughout this period. By contrast, women in the United States, Denmark, and England and Wales had much higher smoking-related mortality during this period, and their life expectancy slowed significantly relative to the other cluster of countries. The Netherlands was something of an anomaly, with lung cancer mortality trends falling somewhere between those of the two clusters. The reason, Staetsky concludes, is that women in the Netherlands took up smoking somewhat more slowly than women in the United States and Denmark, although more rapidly than women in the other cluster, so smoking affected their health to a degree falling somewhere between that in the two clusters.

Staetsky also addresses the issue of the apparent mismatch between the high levels of smoking in Europe today and the lower levels of smoking-related diseases relative to the United States. Statistics show that smoking currently is much more common in most European countries than in the United States among both men and women (British Heart Foundation, 2008). So how could smoking explain the fact that life expectancy has been increasing more slowly for U.S. women than for women in most European countries? The answer lies in the 20- to 30-year period between the time people start smoking and the time major health effects appear. In the period from the 1950s to the 1970s, U.S. women were smoking at a much higher rate than women in most European countries, particularly those in Southern Europe, and it is the smoking behavior during that period that affected life expectancy in the 1980s and 1990s. Now that smoking is more common among women in Europe than among those in the United States, the effects are likely to be seen in life expectancy trends over the next couple of decades.



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